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From psychological moments to mortality: A multidisciplinary synthesis on heart rate variability spanning the continuum of time. Neurosci Biobehav Rev 2017; 83:547-567. [PMID: 28888535 DOI: 10.1016/j.neubiorev.2017.09.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 09/04/2017] [Indexed: 02/05/2023]
Abstract
Heart rate variability (HRV) indexes functioning of the vagus nerve, arguably the most important nerve in the human body. The Neurovisceral Integration Model has provided a structural framework for understanding brain-body integration, highlighting the role of the vagus in adaptation to the environment. In the present paper, we emphasise a temporal framework in which HRV may be considered a missing, structural link between psychological moments and mortality, a proposal we label as Neurovisceral Integration Across a Continuum of Time (or NIACT). This new framework places neurovisceral integration on a dimension of time, highlighting implications for lifespan development and healthy aging, and helping to bridge the gap between clearly demarcated disciplines such as psychology and epidemiology. The NIACT provides a novel framework, which conceptualizes how everyday psychological moments both affect and are affected by the vagus in ways that have long-term effects on mortality risk. We further emphasize that a longitudinal approach to understanding change in vagal function over time may yield novel scientific insights and important public health outcomes.
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202
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Stakenborg N, Wolthuis AM, Gomez-Pinilla PJ, Farro G, Di Giovangiulio M, Bosmans G, Labeeuw E, Verhaegen M, Depoortere I, D'Hoore A, Matteoli G, Boeckxstaens GE. Abdominal vagus nerve stimulation as a new therapeutic approach to prevent postoperative ileus. Neurogastroenterol Motil 2017; 29. [PMID: 28429863 DOI: 10.1111/nmo.13075] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/23/2017] [Accepted: 02/27/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Electrical stimulation of the cervical vagus nerve (VNS) prevents postoperative ileus (POI) in mice. As this approach requires an additional cervical procedure, we explored the possibility of peroperative abdominal VNS in mice and human. METHODS The effect of cervical and abdominal VNS was studied in a murine model of POI and lipopolysaccharide (LPS)-induced sepsis. Postoperative ileus was quantified by assessment of intestinal transit of fluorescent dextran expressed as geometric center (GC). Next, the effect of cervical and abdominal VNS on heart rate was determined in eight Landrace pigs to select the optimal electrode for VNS in human. Finally, the effect of sham or abdominal VNS on LPS-induced cytokine production of whole blood was studied in patients undergoing colorectal surgery. KEY RESULTS Similar to cervical VNS, abdominal VNS significantly decreased LPS-induced serum tumor necrosis factor-α (TNFα) levels (abdominal VNS: 366±33 pg/mL vs sham: 822±105 pg/mL; P<.01). In line, in a murine model of POI, abdominal VNS significantly improved intestinal transit (GC: sham 5.1±0.2 vs abdominal VNS: 7.8±0.6; P<.01) and reduced intestinal inflammation (abdominal VNS: 35±7 vs sham: 80±8 myeloperoxidase positive cells/field; P<.05). In pigs, heart rate was reduced by cervical VNS but not by abdominal VNS. In humans, abdominal VNS significantly reduced LPS-induced IL8 and IL6 production by whole blood. CONCLUSIONS & INFERENCES Abdominal VNS is feasible and safe in humans and has anti-inflammatory properties. As abdominal VNS improves POI similar to cervical VNS in mice, our data indicate that peroperative abdominal VNS may represent a novel approach to shorten POI in man.
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Affiliation(s)
- N Stakenborg
- Translational Research Center for GastroIntestinal Disorders (TARGID), Intestinal Neuroimmune Interactions, University of Leuven, Leuven, Belgium
| | - A M Wolthuis
- Department of Abdominal Surgery, University Hospital of Leuven, Leuven, Belgium
| | - P J Gomez-Pinilla
- Translational Research Center for GastroIntestinal Disorders (TARGID), Intestinal Neuroimmune Interactions, University of Leuven, Leuven, Belgium
| | - G Farro
- Translational Research Center for GastroIntestinal Disorders (TARGID), Intestinal Neuroimmune Interactions, University of Leuven, Leuven, Belgium
| | - M Di Giovangiulio
- Translational Research Center for GastroIntestinal Disorders (TARGID), Intestinal Neuroimmune Interactions, University of Leuven, Leuven, Belgium
| | - G Bosmans
- Translational Research Center for GastroIntestinal Disorders (TARGID), Intestinal Neuroimmune Interactions, University of Leuven, Leuven, Belgium
| | - E Labeeuw
- Translational Research Center for GastroIntestinal Disorders (TARGID), Intestinal Neuroimmune Interactions, University of Leuven, Leuven, Belgium
| | - M Verhaegen
- Department of Anesthesiology, University Hospital of Leuven, Leuven, Belgium
| | - I Depoortere
- Translational Research Center for Gastrointestinal Disorders, Gut Peptide Research Lab, University of Leuven, Leuven, Belgium
| | - A D'Hoore
- Department of Abdominal Surgery, University Hospital of Leuven, Leuven, Belgium
| | - G Matteoli
- Translational Research Center for GastroIntestinal Disorders (TARGID), Laboratory of Mucosal Immunology, University of Leuven, Leuven, Belgium
| | - G E Boeckxstaens
- Translational Research Center for GastroIntestinal Disorders (TARGID), Intestinal Neuroimmune Interactions, University of Leuven, Leuven, Belgium
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203
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De Rinaldis M, Gigante N, Trabacca A. Unusual early positive outcome of VNS therapy: anecdotal honeymoon or atypical prolonged immediate changes? Acta Neurol Belg 2017; 117:793-794. [PMID: 28299595 DOI: 10.1007/s13760-017-0767-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
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204
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François M, Qualls-Creekmore E, Berthoud HR, Münzberg H, Yu S. Genetics-based manipulation of adipose tissue sympathetic innervation. Physiol Behav 2017; 190:21-27. [PMID: 28859876 DOI: 10.1016/j.physbeh.2017.08.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/25/2017] [Accepted: 08/26/2017] [Indexed: 12/17/2022]
Abstract
There is renewed interest in leveraging the thermogenic capacity of brown adipose tissue (BAT) and browning of white adipose tissue (WAT) to improve energy balance and prevent obesity. In addition to these effects on energy expenditure, both BAT and WAT secrete large numbers of hormones and cytokines that play important roles in maintaining metabolic health. Both BAT and WAT are densely innervated by the sympathetic nervous system (SNS) and this innervation is crucial for BAT thermogenesis and WAT browning, making it a potentially interesting target for manipulating energy balance and treatment of obesity and metabolic disease. Peripheral neuromodulation in the form of electrical manipulation of the SNS and parasympathetic nervous system (PSNS) has been used for the management of pain and many other conditions, but progress is hampered by lack of detailed knowledge of function-specific neurons and nerves innervating particular organs and tissues. Therefore, the goal of the National Institutes of Health (NIH) Common Fund project "Stimulating Peripheral Activity to Relieve Conditions (SPARC)" is to comprehensively map both anatomical and neurochemical aspects of the peripheral nervous system in animal model systems to ultimately guide optimal neuromodulation strategies in humans. Compared to electrical manipulation, neuron-specific opto- and chemogenetic manipulation, now being extensively used to decode the function of brain circuits, will further increase the functional specificity of peripheral neuromodulation.
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Affiliation(s)
- Marie François
- Neurobiology of Nutrition and Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Emily Qualls-Creekmore
- Neurobiology of Nutrition and Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Hans-Rudolf Berthoud
- Neurobiology of Nutrition and Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Heike Münzberg
- Neurobiology of Nutrition and Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
| | - Sangho Yu
- Neurobiology of Nutrition and Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA.
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205
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Koenig J, Rash JA, Campbell TS, Thayer JF, Kaess M. A Meta-Analysis on Sex Differences in Resting-State Vagal Activity in Children and Adolescents. Front Physiol 2017; 8:582. [PMID: 28883794 PMCID: PMC5573740 DOI: 10.3389/fphys.2017.00582] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/28/2017] [Indexed: 12/17/2022] Open
Abstract
Lower vagal activity is associated with psychopathology independent of age. Research suggests that alterations of vagal activity precede the development of psychopathology. The present review aimed to quantify sex differences in vagal activity in children and adolescents. Studies reporting on sex differences on measures of vagally-mediated heart rate variability derived from short-term recordings under resting conditions in boys and girls were included. Drawing on data from more than 5,000 children and adolescents, we provide evidence that healthy young girls display lower vagal activity and greater mean heart rate compared to boys, a finding that may have implications for risk associated with the development of internalizing psychopathology and somatic ill-health.
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Affiliation(s)
- Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of HeidelbergHeidelberg, Germany
| | - Joshua A Rash
- Department of Psychology, University of CalgaryCalgary, AB, Canada.,Department of Psychology, Memorial University of NewfoundlandSt. John's, NL, Canada
| | - Tavis S Campbell
- Department of Psychology, University of CalgaryCalgary, AB, Canada
| | - Julian F Thayer
- Department of Psychology, The Ohio State UniversityColumbus, OH, United States
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of HeidelbergHeidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of BernBern, Switzerland
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206
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Kul’chyns’kyi AB, Kyjenko VM, Zukow W, Popovych IL. Causal Neuro-immune Relationships at Patients with Chronic Pyelonephritis and Cholecystitis. Correlations between Parameters EEG, HRV and White Blood Cell Count. Open Med (Wars) 2017; 12:201-213. [PMID: 28730179 PMCID: PMC5506393 DOI: 10.1515/med-2017-0030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 04/24/2017] [Indexed: 12/30/2022] Open
Abstract
We aim to analyze in bounds KJ Tracey's immunological homunculus conception the relationships between parameters of electroencephalogram (EEG) and heart rate variability (HRV), on the one hand, and the parameters of bhite blood cell count, on the other hand. METHODS In basal conditions in 23 men, patients with chronic pyelonephritis and cholecystitis in remission, recorded EEG ("NeuroCom Standard", KhAI Medica, Ukraine) and HRV ("Cardiolab+VSR", KhAI Medica, Ukraine). In portion of blood counted up white blood cell count. RESULTS Revealed that canonical correlation between constellation EEG and HRV parameters form with blood level of leukocytes 0.92 (p<10-5), with relative content in white blood cell count stubnuclear neutrophiles 0.93 (p<10-5), segmentonucleary neutrophiles 0.89 (p<10-3), eosinophiles 0.87 (p=0.003), lymphocytes 0.77 (p<10-3) and with monocytes 0.75 (p=0.003). CONCLUSION Parameters of white blood cell count significantly modulated by electrical activity some structures of central and autonomic nervous systems.
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Affiliation(s)
| | - Valeriy M Kyjenko
- Laboratory of Experimental Balneology, OO Bogomoletz Institute of Physiology NAS, Kyiv, Ukraine
| | - Walery Zukow
- Faculty of Physical Education, Health and Tourism, Kazimierz Wielki University, Bydgoszcz, Poland
| | - Igor L Popovych
- Laboratory of Experimental Balneology, OO Bogomoletz Institute of Physiology NAS, Kyiv, Ukraine
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207
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Cognitive effects of subdiaphragmatic vagal deafferentation in rats. Neurobiol Learn Mem 2017; 142:190-199. [DOI: 10.1016/j.nlm.2017.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 04/22/2017] [Accepted: 05/07/2017] [Indexed: 12/26/2022]
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208
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Bonaz B, Sinniger V, Pellissier S. Vagus nerve stimulation: a new promising therapeutic tool in inflammatory bowel disease. J Intern Med 2017; 282:46-63. [PMID: 28421634 DOI: 10.1111/joim.12611] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Inflammatory bowel disease (IBD), that is Crohn's disease (CD) and ulcerative colitis, affects about 1.5 million persons in the USA and 2.2 million in Europe. The pathophysiology of IBD involves immunological, genetic and environmental factors. The treatment is medico-surgical but suspensive. Anti-TNFα agents have revolutionized the treatment of IBD but have side effects. In addition, a non-negligible percentage of patients with IBD stop or take episodically their treatment. Consequently, a nondrug therapy targeting TNFα through a physiological pathway, devoid of major side effects and with a good cost-effectiveness ratio, would be of interest. The vagus nerve has dual anti-inflammatory properties through its afferent (i.e. hypothalamic-pituitary-adrenal axis) and efferent (i.e. the anti-TNFα effect of the cholinergic anti-inflammatory pathway) fibres. We have shown that there is an inverse relationship between vagal tone and plasma TNFα level in patients with CD, and have reported, for the first time, that chronic vagus nerve stimulation has anti-inflammatory properties in a rat model of colitis and in a pilot study performed in seven patients with moderate CD. Two of these patients failed to improve after 3 months of vagus nerve stimulation but five were in deep remission (clinical, biological and endoscopic) at 6 months of follow-up and vagal tone was restored. No major side effects were observed. Thus, vagus nerve stimulation provides a new therapeutic option in the treatment of CD.
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Affiliation(s)
- B Bonaz
- University Clinic of Hepato-Gastroenterology, University Hospital, Grenoble, France.,University Grenoble Alpes, Grenoble Institute of Neurosciences (GIN), Inserm (U1216), Grenoble, France
| | - V Sinniger
- University Clinic of Hepato-Gastroenterology, University Hospital, Grenoble, France.,University Grenoble Alpes, Grenoble Institute of Neurosciences (GIN), Inserm (U1216), Grenoble, France
| | - S Pellissier
- University Clinic of Hepato-Gastroenterology, University Hospital, Grenoble, France.,Laboratoire Inter-Universitaire de Psychologie, Personnalité, Cognition et Changement Social (LIP/PC2S), University Savoie Mont-Blanc, Chambéry, France
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209
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Abstract
Major depressive disorder (MDD) is prevalent. Although standards antidepressants are more effective than placebo, up to 35% of patients do not respond to 4 or more conventional treatments and are considered to have treatment-resistant depression (TRD). Considerable effort has been devoted to trying to find effective treatments for TRD. This review focuses on vagus nerve stimulation (VNS), approved for TRD in 2005 by the Food and Drugs Administration. Stimulation is carried by bipolar electrodes on the left cervical vagus nerve, which are attached to an implanted stimulator generator. The vagus bundle contains about 80% of afferent fibers terminating in the medulla, from which there are projections to many areas of brain, including the limbic forebrain. Various types of brain imaging studies reveal widespread functional effects in brain after either acute or chronic VNS. Although more randomized control trials of VNS need to be carried out before a definitive conclusion can be reached about its efficacy, the results of open studies, carried out over period of 1 to 2 years, show much more efficacy when compared with results from treatment as usual studies. There is an increase in clinical response to VNS between 3 and 12 months, which is quite different from that seen with standard antidepressant treatment of MDD. Preclinically, VNS affects many of the same brain areas, neurotransmitters (serotonin, norepinephrine) and signal transduction mechanisms (brain-derived neurotrophic factor-tropomyosin receptor kinase B) as those found with traditional antidepressants. Nevertheless, the mechanisms by which VNS benefits patients nonresponsive to conventional antidepressants is unclear, with further research needed to clarify this.
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Affiliation(s)
- Flavia R Carreno
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
- Center for Biomedical Neuroscience, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Alan Frazer
- Department of Pharmacology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Center for Biomedical Neuroscience, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
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210
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Abstract
A major challenge in the growing field of bioelectronic medicine is the development of tissue interface technologies promoting device integration with biological tissues. Materials based on organic bioelectronics show great promise due to a unique combination of electronic and ionic conductivity properties. In this review, we outline exciting developments in the field of organic bioelectronics and demonstrate the medical importance of these active, electronically controllable materials. Importantly, organic bioelectronics offer a means to control cell-surface attachment as required for many device-tissue applications. Experiments have shown that cells readily attach and proliferate on reduced but not oxidized organic bioelectronic materials. In another application, the active properties of organic bioelectronics were used to develop electronically triggered systems for drug release. After incorporating drugs by advanced loading strategies, small compound drugs were released upon electrochemical trigger, independent of charge. Another type of delivery device was used to achieve well-controlled, spatiotemporal delivery of cationic drugs. Via electrophoretic transport within a polymer, cations were delivered with single-cell precision. Finally, organic bioelectronic materials are commonly used as electrode coatings improving the electrical properties of recording and stimulation electrodes. Because such coatings drastically reduce the electrode impedance, smaller electrodes with improved signal-to-noise ratio can be fabricated. Thus, rapid technological advancement combined with the creation of tiny electronic devices reacting to changes in the tissue environment helps to promote the transition from standard pharmaceutical therapy to treatment based on 'electroceuticals'. Moreover, the widening repertoire of organic bioelectronics will expand the options for true biological interfaces, providing the basis for personalized bioelectronic medicine.
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Affiliation(s)
- S Löffler
- Swedish Medical Nanoscience Center, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - K Melican
- Swedish Medical Nanoscience Center, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - K P R Nilsson
- Division of Chemistry, Department of Physics, Chemistry and Biology, Linköping University, Linköping, Sweden
| | - A Richter-Dahlfors
- Swedish Medical Nanoscience Center, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
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211
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Ekmekçi H, Kaptan H. Vagus Nerve Stimulation. Open Access Maced J Med Sci 2017; 5:391-394. [PMID: 28698761 PMCID: PMC5503741 DOI: 10.3889/oamjms.2017.056] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/11/2017] [Accepted: 03/31/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND: The vagus nerve stimulation (VNS) is an approach mainly used in cases of intractable epilepsy despite all the efforts. Also, its benefits have been shown in severe cases of depression resistant to typical treatment. AIM: The aim of this study was to present current knowledge of vagus nerve stimulation. MATERIAL AND METHODS: A new value has emerged just at this stage: VNS aiming the ideal treatment with new hopes. It is based on the placement of a programmable generator on the chest wall. Electric signals from the generator are transmitted to the left vagus nerve through the connection cable. Control on the cerebral bioelectrical activity can be achieved by way of these signal sent from there in an effort for controlling the epileptic discharges. RESULTS: The rate of satisfactory and permanent treatment in epilepsy with monotherapy is around 50%. This rate will increase by one-quarters (25%) with polytherapy. However, there is a patient group roughly constituting one-thirds of this population, and this group remains unresponsive or refractory to all the therapies and combined regimes. The more the number of drugs used, the more chaos and side effects are observed. The anti-epileptic drugs (AEDs) used will have side effects on both the brain and the systemic organs. Cerebral resection surgery can be required in some patients. The most commonly encountered epilepsy type is the partial one, and the possibility of benefiting from invasive procedures is limited in most patients of this type. Selective amygdala-hippocampus surgery is a rising value in complex partial seizures. Therefore, as epilepsy surgery can be performed in very limited numbers and rather developed centres, success can also be achieved in limited numbers of patients. The common ground for all the surgical procedures is the target of preservation of memory, learning, speaking, temper and executive functions as well as obtaining a good control on seizures. However, the action mechanism of VNS is still not exactly known. On the other hand, it appears to be a reliable method that is tolerated well in partial resistant seizures. It has been observed that adverse effects are generally of mild-medium severity, and most of the problems can be eliminated easily through the re-adjustment of the stimulator. CONCLUSION: VNS, which is a treatment modality that will take place it deserves in epilepsy treatment with “the correct patient” and “correct reason”, must be known better and its applications must be developed.
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Affiliation(s)
- Hakan Ekmekçi
- Selcuk University, Faculty of Medicine, Department of Neurology, Konya, Turkey
| | - Hülagu Kaptan
- Dokuz Eylül University, Medical Faculty, Inciralti 35340, Izmir, Turkey
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212
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Numerical modeling of percutaneous auricular vagus nerve stimulation: a realistic 3D model to evaluate sensitivity of neural activation to electrode position. Med Biol Eng Comput 2017; 55:1763-1772. [DOI: 10.1007/s11517-017-1629-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 02/06/2017] [Indexed: 01/09/2023]
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213
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Sahyouni R, Chang DT, Moshtaghi O, Mahmoodi A, Djalilian HR, Lin HW. Functional and Histological Effects of Chronic Neural Electrode Implantation. Laryngoscope Investig Otolaryngol 2017; 2:80-93. [PMID: 28894826 PMCID: PMC5527370 DOI: 10.1002/lio2.66] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 12/27/2022] Open
Abstract
Objectives Permanent injury to the cranial nerves can often result in a substantial reduction in quality of life. Novel and innovative interventions can help restore form and function in nerve paralysis, with bioelectric interfaces among the more promising of these approaches. The foreign body response is an important consideration for any bioelectric device as it influences the function and effectiveness of the implant. The purpose of this review is to describe tissue and functional effects of chronic neural implantation among the different categories of neural implants and highlight advances in peripheral and cranial nerve stimulation. Data Sources: PubMed, IEEE, and Web of Science literature search. Review Methods: A review of the current literature was conducted to examine functional and histologic effects of bioelectric interfaces for neural implants. Results Bioelectric devices can be characterized as intraneural, epineural, perineural, intranuclear, or cortical depending on their placement relative to nerves and neuronal cell bodies. Such devices include nerve‐specific stimulators, neuroprosthetics, brainstem implants, and deep brain stimulators. Regardless of electrode location and interface type, acute and chronic histological, macroscopic and functional changes can occur as a result of both passive and active tissue responses to the bioelectric implant. Conclusion A variety of chronically implantable electrodes have been developed to treat disorders of the peripheral and cranial nerves, to varying degrees of efficacy. Consideration and mitigation of detrimental effects at the neural interface with further optimization of functional nerve stimulation will facilitate the development of these technologies and translation to the clinic. Level of Evidence 3.
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Affiliation(s)
- Ronald Sahyouni
- Department of Biomedical Engineering, University of California Irvine U.S.A
| | - David T Chang
- Department of Otolaryngology-Head & Neck Surgery, University of California Irvine U.S.A.,Division of Otolaryngology-Head &Neck Surgery, Irvine, California, Children's Hospital of Orange County Orange California U.S.A
| | - Omid Moshtaghi
- School of Medicine, University of California Irvine U.S.A
| | - Amin Mahmoodi
- Department of Biomedical Engineering, University of California Irvine U.S.A
| | - Hamid R Djalilian
- Department of Otolaryngology-Head & Neck Surgery, University of California Irvine U.S.A
| | - Harrison W Lin
- Department of Otolaryngology-Head & Neck Surgery, University of California Irvine U.S.A
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214
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Vagus Nerve Stimulation and Other Neuromodulation Methods for Treatment of Traumatic Brain Injury. Neurocrit Care 2017; 24:308-19. [PMID: 26399249 DOI: 10.1007/s12028-015-0203-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The objective of this paper is to review the current literature regarding the use of vagus nerve stimulation (VNS) in preclinical models of traumatic brain injury (TBI) as well as discuss the potential role of VNS along with alternative neuromodulation approaches in the treatment of human TBI. Data from previous studies have demonstrated VNS-mediated improvement following TBI in animal models. In these cases, VNS was observed to enhance motor and cognitive recovery, attenuate cerebral edema and inflammation, reduce blood brain barrier breakdown, and confer neuroprotective effects. Yet, the underlying mechanisms by which VNS enhances recovery following TBI remain to be fully elucidated. Several hypotheses have been offered including: a noradrenergic mechanism, reduction in post-TBI seizures and hyper-excitability, anti-inflammatory effects, attenuation of blood-brain barrier breakdown, and cerebral edema. We present other potential mechanisms by which VNS acts including enhancement of synaptic plasticity and recruitment of endogenous neural stem cells, stabilization of intracranial pressure, and interaction with the ghrelin system. In addition, alternative methods for the treatment of TBI including deep brain stimulation, transcranial magnetic stimulation, transcranial direct current stimulation, and focused ultrasound stimulation are discussed. Although the primary source data show that VNS improves TBI outcomes, it remains to be determined if these findings can be translated to clinical settings.
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215
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San-Juan D, Espinoza López DA, Vázquez Gregorio R, Trenado C, Fernández-González Aragón M, Morales-Quezada L, Hernandez Ruiz A, Hernandez-González F, Alcaraz-Guzmán A, Anschel DJ, Fregni F. Transcranial Direct Current Stimulation in Mesial Temporal Lobe Epilepsy and Hippocampal Sclerosis. Brain Stimul 2017; 10:28-35. [DOI: 10.1016/j.brs.2016.08.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 08/23/2016] [Accepted: 08/29/2016] [Indexed: 11/26/2022] Open
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216
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Hulsey DR, Riley JR, Loerwald KW, Rennaker RL, Kilgard MP, Hays SA. Parametric characterization of neural activity in the locus coeruleus in response to vagus nerve stimulation. Exp Neurol 2016; 289:21-30. [PMID: 27988257 DOI: 10.1016/j.expneurol.2016.12.005] [Citation(s) in RCA: 182] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/04/2016] [Accepted: 12/12/2016] [Indexed: 01/14/2023]
Abstract
Vagus nerve stimulation (VNS) has emerged as a therapy to treat a wide range of neurological disorders, including epilepsy, depression, stroke, and tinnitus. Activation of neurons in the locus coeruleus (LC) is believed to mediate many of the effects of VNS in the central nervous system. Despite the importance of the LC, there is a dearth of direct evidence characterizing neural activity in response to VNS. A detailed understanding of the brain activity evoked by VNS across a range of stimulation parameters may guide selection of stimulation regimens for therapeutic use. In this study, we recorded neural activity in the LC and the mesencephalic trigeminal nucleus (Me5) in response to VNS over a broad range of current amplitudes, pulse frequencies, train durations, inter-train intervals, and pulse widths. Brief 0.5s trains of VNS drive rapid, phasic firing of LC neurons at 0.1mA. Higher current intensities and longer pulse widths drive greater increases in LC firing rate. Varying the pulse frequency substantially affects the timing, but not the total amount, of phasic LC activity. VNS drives pulse-locked neural activity in the Me5 at current levels above 1.2mA. These results provide insight into VNS-evoked phasic neural activity in multiple neural structures and may be useful in guiding the selection of VNS parameters to enhance clinical efficacy.
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Affiliation(s)
- Daniel R Hulsey
- The University of Texas at Dallas, School of Behavioral Brain Sciences, BSB 14, Richardson, TX 75080, United States; Texas Biomedical Device Center, BSB 11, Richardson, TX 75080, United States
| | - Jonathan R Riley
- The University of Texas at Dallas, School of Behavioral Brain Sciences, BSB 14, Richardson, TX 75080, United States; Texas Biomedical Device Center, BSB 11, Richardson, TX 75080, United States
| | | | - Robert L Rennaker
- The University of Texas at Dallas, School of Behavioral Brain Sciences, BSB 14, Richardson, TX 75080, United States; Texas Biomedical Device Center, BSB 11, Richardson, TX 75080, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, 800 West Campbell Road, BSB 11, Richardson, TX 75080-3021, United States
| | - Michael P Kilgard
- The University of Texas at Dallas, School of Behavioral Brain Sciences, BSB 14, Richardson, TX 75080, United States; Texas Biomedical Device Center, BSB 11, Richardson, TX 75080, United States
| | - Seth A Hays
- Texas Biomedical Device Center, BSB 11, Richardson, TX 75080, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, 800 West Campbell Road, BSB 11, Richardson, TX 75080-3021, United States.
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217
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Schneider R, Randolph GW, Barczynski M, Dionigi G, Wu CW, Chiang FY, Machens A, Kamani D, Dralle H. Continuous intraoperative neural monitoring of the recurrent nerves in thyroid surgery: a quantum leap in technology. Gland Surg 2016; 5:607-616. [PMID: 28149807 PMCID: PMC5233836 DOI: 10.21037/gs.2016.11.10] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/18/2016] [Indexed: 12/28/2022]
Abstract
The continuous intraoperative neural monitoring (CIONM) technique is increasingly acknowledged as a useful tool to recognize impending nerve injury and to abort the related manoeuvre to prevent nerve injury during thyroid surgery. CIONM provides valuable real-time information constantly, which is really useful during complex thyroid surgeries especially in the settings of unusual anatomy. Thus, CIONM overcomes the key methodological limitation inherent in intermittent nerve monitoring (IINOM); which is allowing the nerve to be at risk in between the stimulations. The clinically important combined electromyographic (EMG) event, indicative of impending recurrent laryngeal nerve (RLN) injury, prevents the majority of traction related injuries to the anatomically intact RLN enabling modification of the causative surgical manoeuvre in 80% of cases. These EMG changes can progress to loss of EMG signal with postoperative vocal cord palsy (VCP) if corrective action is not taken. As a further extension, CIONM also helps to identify intraoperative functional nerve recovery with restitution of amplitude to ≥50% of initial baseline; this allows continuing of resection of contralateral side. CIONM facilitates for early corrective action before permanent damage to the nerve has been done. CIONM is a recent but rapidly evolving technique, constantly being refined by various studies focusing on improvement in its implementation and interpretation, as well as on the elimination of the technical snags.
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Affiliation(s)
- Rick Schneider
- Medical Faculty, Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Gregory W. Randolph
- Division of Thyroid and Parathyroid Surgery Harvard Medical School, Boston, Massachusetts, USA
| | - Marcin Barczynski
- Department of Endocrine Surgery, 3 Chair of General Surgery, Jagiellonian University, Krakow, Poland
| | | | - Che-Wei Wu
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Feng-Yu Chiang
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Andreas Machens
- Medical Faculty, Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Surgery Harvard Medical School, Boston, Massachusetts, USA
| | - Henning Dralle
- Medical Faculty, Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
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218
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Kar SK, Sarkar S. Neuro-stimulation Techniques for the Management of Anxiety Disorders: An Update. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2016; 14:330-337. [PMID: 27776384 PMCID: PMC5083940 DOI: 10.9758/cpn.2016.14.4.330] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 05/30/2016] [Accepted: 06/08/2016] [Indexed: 12/23/2022]
Abstract
Neuro-stimulation techniques have gradually evolved over the decades and have emerged potential therapeutic modalities for the treatment of psychiatric disorders, especially treatment refractory cases. The neuro-stimulation techniques involves modalities like electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS) and others. This review discusses the role of neuro-stimulation techniques in the treatment of anxiety disorders. The various modalities of neuro-stimulation techniques are briefly discussed. The evidence base relating to use of these techniques in the treatment of anxiety disorders is discussed further. The review then highlights the challenges in conducting research in relation to the use of neuro-stimulation techniques with reference to patients with anxiety disorders. The review provides the future directions of research and aimed at expanding the evidence base of treatment of anxiety disorders and providing neuro-stimulation techniques as promising effective and acceptable alternative in select cases.
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Affiliation(s)
- Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, India
| | - Siddharth Sarkar
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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219
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Yakunina N, Kim SS, Nam EC. Optimization of Transcutaneous Vagus Nerve Stimulation Using Functional MRI. Neuromodulation 2016; 20:290-300. [PMID: 27898202 DOI: 10.1111/ner.12541] [Citation(s) in RCA: 245] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 09/11/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE/HYPOTHESIS Vagus nerve stimulation (VNS) is an established therapy for drug-resistant epilepsy, depression, and a number of other disorders. Transcutaneous stimulation of the auricular branch of the vagus nerve (tVNS) has been considered as a non-invasive alternative. Several functional magnetic resonance imaging (fMRI) studies on the effects of tVNS used different stimulation parameters and locations in the ear, which makes it difficult to determine the optimal tVNS methodology. The present study used fMRI to determine the most effective location for tVNS. MATERIALS AND METHODS Four stimulation locations in the ear were compared: the inner tragus, inferoposterior wall of the ear canal, cymba conchae, and earlobe (sham). Thirty-seven healthy subjects underwent two 6-min tVNS stimulation runs per electrode location (monophasic rectangular 500 μs pulses, 25 Hz). General linear model was performed using SPM; region-of-interest analyses were performed for the brainstem areas. RESULTS Stimulation at the ear canal resulted in the weakest activation of the nucleus of solitary tract (NTS), the recipient of most afferent vagal projections, and of the locus coeruleus (LC), a brainstem nucleus that receives direct input from the NTS. Stimulation of the inner tragus and cymba conchae activated these two nuclei as compared to sham. However, ROI analysis showed that only stimulation of the cymba conchae produced a significantly stronger activation in both the NTS and LC than did the sham stimulation. CONCLUSIONS These findings suggest that tVNS at the cymba conchae properly activates the vagal pathway and results in its strongest activation, and thus may be the optimal location for tVNS therapies applied to the auricle.
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Affiliation(s)
- Natalia Yakunina
- Institute of Medical Science, School of Medicine, Kangwon National University, Kangwondaehak-gil 1, Chuncheon, Republic of Korea.,Neuroscience Research Institute, Kangwon National University Hospital, Baengnyeong-ro 156, Chuncheon, Republic of Korea
| | - Sam Soo Kim
- Neuroscience Research Institute, Kangwon National University Hospital, Baengnyeong-ro 156, Chuncheon, Republic of Korea.,Department of Radiology, School of Medicine, Kangwon National University, Kangwondaehak-gil 1, Chuncheon, Republic of Korea
| | - Eui-Cheol Nam
- Neuroscience Research Institute, Kangwon National University Hospital, Baengnyeong-ro 156, Chuncheon, Republic of Korea.,Department of Otolaryngology, School of Medicine, Kangwon National University, Kangwondaehak-gil 1, Chuncheon, Republic of Korea
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220
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Bienenstock J, Kunze W, Forsythe P. The Microbiome–Gut–Brain Axis and the Consequences of Infection and Dysbiosis. ACTA ACUST UNITED AC 2016. [DOI: 10.1038/ajgsup.2016.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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221
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Normann RA, Fernandez E. Clinical applications of penetrating neural interfaces and Utah Electrode Array technologies. J Neural Eng 2016; 13:061003. [PMID: 27762237 DOI: 10.1088/1741-2560/13/6/061003] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This paper briefly describes some of the recent progress in the development of penetrating microelectrode arrays and highlights the use of two of these devices, Utah electrode arrays and Utah slanted electrode arrays, in two therapeutic interventions: recording volitional skeletal motor commands from the central nervous system, and recording motor commands and evoking somatosensory percepts in the peripheral nervous system (PNS). The paper also briefly explores other potential sites for microelectrode array interventions that could be profitably pursued and that could have important consequences in enhancing the quality of life of patients that has been compromised by disorders of the central and PNSs.
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Affiliation(s)
- Richard A Normann
- Departments of Bioengineering and Ophthalmology, University of Utah, Salt Lake City, UT 84112, USA
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222
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Bruch JD. Intestinal infection associated with future onset of an anxiety disorder: Results of a nationally representative study. Brain Behav Immun 2016; 57:222-226. [PMID: 27223096 DOI: 10.1016/j.bbi.2016.05.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/11/2016] [Accepted: 05/15/2016] [Indexed: 01/05/2023] Open
Abstract
Recent research involving mice suggests a possible relationship between intestinal infection and future anxiety-like behavior. However, there has been little epidemiological research showing such a connection in humans. This study uses the Medical Expenditure Panel Survey (MEPS) to assess longitudinally the association between intestinal infection and later onset of an anxiety disorder, through a nationally representative sample. Six 2-year panel datasets, each comprised of 5 consecutive rounds, were pooled from 2007 to 2013 to gather records for all respondents 18years of age or older that did not have an anxiety disorder in Round 1 (n=63, 133 people). Within the study sample, there were 2577 individuals with an intestinal infection in Round 1 and 4239 individuals with an anxiety disorder that began in Round 2, 3, 4, or 5. Overall, intestinal infection in Round 1 was associated with a 1.34 (P<0.01) odds ratio of having an anxiety disorder that began in Round 2, 3, 4, or 5. Separate analyses were performed to determine whether the association applied to other infection types, including respiratory infection, urinary tract infection, hepatitis infection, and skin infection. Respiratory infection was associated with a 1.36 (P<0.01) odds ratio of having an anxiety disorder that began in Round 2, 3, 4, or 5; no other infection type showed a significant association. More research on human populations is needed to examine the apparent association and explore potential mechanisms by which gut pathogens might influence anxiety.
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Affiliation(s)
- Joseph D Bruch
- University of Pennsylvania, 309 S. 41st Street Apt. 2, Philadelphia, PA 19104, United States.
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223
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Yoo PB, Liu H, Hincapie JG, Ruble SB, Hamann JJ, Grill WM. Modulation of heart rate by temporally patterned vagus nerve stimulation in the anesthetized dog. Physiol Rep 2016; 4:4/2/e12689. [PMID: 26811057 PMCID: PMC4760392 DOI: 10.14814/phy2.12689] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Despite current knowledge of the myriad physiological effects of vagus nerve stimulation (VNS) in various mammalian species (including humans), the impact of varying stimulation parameters on nerve recruitment and physiological responses is not well understood. We investigated nerve recruitment, cardiovascular responses, and skeletal muscle responses to different temporal patterns of VNS across 39 combinations of stimulation amplitude, frequency, and number of pulses per burst. Anesthetized dogs were implanted with stimulating and recording cuff electrodes around the cervical vagus nerve, whereas laryngeal electromyogram (EMG) and heart rate were recorded. In seven of eight dogs, VNS‐evoked bradycardia (defined as ≥10% decrease in heart rate) was achieved by applying stimuli at amplitudes equal to or greater than the threshold for activating slow B‐fibers. Temporally patterned VNS (minimum 5 pulses per burst) was sufficient to elicit bradycardia while reducing the concomitant activation of laryngeal muscles by more than 50%. Temporal patterns of VNS can be used to modulate heart rate while minimizing laryngeal motor fiber activation, and this is a novel approach to reduce the side effects produced by VNS.
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Affiliation(s)
- Paul B Yoo
- Department of Biomedical Engineering, Duke University, Durham, North Carolina Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada Department of Electrical and Computer Engineering, University of Toronto, Toronto, Canada
| | - Haoran Liu
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Juan G Hincapie
- Cardiac Rhythm Management, Boston Scientific Corporation, St Paul, Minnesota
| | - Stephen B Ruble
- Cardiac Rhythm Management, Boston Scientific Corporation, St Paul, Minnesota
| | - Jason J Hamann
- Cardiac Rhythm Management, Boston Scientific Corporation, St Paul, Minnesota
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, North Carolina Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina Department of Neurobiology, Duke University, Durham, North Carolina Department of Surgery, Duke University, Durham, North Carolina
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224
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Panebianco M, Zavanone C, Dupont S, Restivo DA, Pavone A. Vagus nerve stimulation therapy in partial epilepsy: a review. Acta Neurol Belg 2016; 116:241-8. [PMID: 26908034 DOI: 10.1007/s13760-016-0616-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/05/2016] [Indexed: 01/09/2023]
Abstract
Epilepsy is a chronic neurological disorder characterized by recurrent, unprovoked epileptic seizures. The majority of people given a diagnosis of epilepsy have a good prognosis, but 20-30 % will develop drug-resistant epilepsy. Vagus nerve stimulation (VNS) is a neuromodulatory treatment that is used as an adjunctive therapy for treating people with medically refractory epilepsy. It consists of chronic intermittent electrical stimulation of the vagus nerve, delivered by a programmable pulse generator (Neuro-Cybernetic Prosthesis). In 1997, the Food and Drug Administration approved VNS as adjunctive treatment for medically refractory partial-onset seizures in adults and adolescents. This article reviews the literature from 1988 to nowadays. We discuss thoroughly the anatomy and physiology of vagus nerve and the potential mechanisms of actions and clinical applications involved in VNS therapy, as well as the management, safety, tolerability and effectiveness of VNS therapy. VNS for partial seizures appears to be an effective and well tolerated treatment in adult and pediatric patients. People noted improvements in feelings of well-being, alertness, memory and thinking skills, as well as mood. The adverse effect profile is substantially different from the adverse effect profile associated with antiepileptic drugs, making VNS a potential alternative for patients with difficulty tolerating antiepileptic drug adverse effects. Despite the passing years and the advent of promising neuromodulation technologies, VNS remains an efficacy treatment for people with medically refractory epilepsy. Past and ongoing investigations in other indications have provided signals of the therapeutic potential in a wide variety of conditions.
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Affiliation(s)
- Mariangela Panebianco
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, Clinical Sciences Centre for Research and Education, Lower Lane, University of Liverpool, Liverpool, L9 7LJ, UK.
| | - Chiara Zavanone
- Rehabilitation Unit, Pitié-Salpêtrière Hospital, APHP, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Sophie Dupont
- Epilepsy Unit and Rehabilitation Unit, Pitié-Salpêtrière Hospital, APHP, 47-83, boulevard de l'Hôpital, 75013, Paris, France
- Centre de Recherche de l'Institut du Cerveau et de la Moëlle Epinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 INSERM, Université Pierre et Marie Curie, 4, place Jussieu, 75005, Paris, France
| | - Domenico A Restivo
- Department of Internal Medicine, Neurologic Unit, Garibaldi Hospital, 5, Piazza Santa Maria di Gesù, 95124, Catania, Italy
| | - Antonino Pavone
- Department of Internal Medicine, Neurologic Unit, Garibaldi Hospital, 5, Piazza Santa Maria di Gesù, 95124, Catania, Italy
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225
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Jarczok MN, Koenig J, Li J, Mauss D, Hoffmann K, Schmidt B, Fischer JE, Thayer JF. The Association of Work Stress and Glycemic Status Is Partially Mediated by Autonomic Nervous System Function: Cross-Sectional Results from the Mannheim Industrial Cohort Study (MICS). PLoS One 2016; 11:e0160743. [PMID: 27532642 PMCID: PMC4988666 DOI: 10.1371/journal.pone.0160743] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/25/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Work stress is associated with an increased risk of pre-diabetes, Type 2 diabetes, and inflammation, as well as decreased autonomic nervous system function as measured, for example, via heart rate variability. We investigated the extent to which the association between work stress and glycemic status is mediated by vagally-mediated heart rate variability (vmHRV) and/or inflammation. METHODS Cross-sectional data from the Mannheim Industrial Cohort Study (MICS) with 9,937 participants were analyzed. The root mean squared successive differences (RMSSD) from long-term heart rate monitoring during work and night time periods was used to index vmHRV. Fasting plasma glucose and glycosylated hemoglobin were assessed to determine glycemic status. High sensitive C-reactive protein levels were observed as a measure of systemic inflammation and the Effort-Reward-Imbalance scale was used to evaluate work stress. Mediation models were adjusted for age, sex, and occupational status, and estimations were bootstrapped (5,000 replications). RESULTS Effort-Reward-Imbalance was significantly negatively associated with RMSSD and both glycosylated hemoglobin and fasting plasma glucose during both work and night time periods. Effort-Reward-Imbalance was observed to have a significant direct effect on glycosylated hemoglobin and significant indirect effects, through RMSSD, on both glycemic measures during both time periods. Introducing C-reactive protein as a further mediator to the model did not alter the indirect effects observed. C-reactive protein, as an exclusive mediator, was observed to have smaller direct and indirect effects on the glycemic measures as compared to when Effort-Reward-Imbalance was included in the model. CONCLUSIONS Our results suggest that the association between work stress and glycemic status is partially mediated through vmHRV independent of systemic inflammation as measured by C-reactive protein. We conclude that work stress may be an additional factor that promotes development of hyperglycemic-metabolic states. If supported by prospective evidence, these results may lead to new approaches for primary prevention of hyperglycemia in the workplace.
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Affiliation(s)
- Marc N. Jarczok
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf–Krehl–Strasse 7–11, 68167, Mannheim, Germany
- Institute of Medical Psychology, Center for Psychosocial Medicine, UniversityHospital Heidelberg, Heidelberg, Germany, Bergheimer Strasse 20, 69115, Heidelberg, Germany
| | - Julian Koenig
- The Ohio State University, Department of Psychology, 1835 Neil Avenue, 43210, Columbus, Ohio, United States of America
| | - Jian Li
- Institute of Occupational, Social, and Environmental Medicine, Center for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany
| | - Daniel Mauss
- Department of Occupational Medicine Allianz SE, Königinstrasse 28 80802, Munich, Germany
| | - Kristina Hoffmann
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf–Krehl–Strasse 7–11, 68167, Mannheim, Germany
| | - Burkhard Schmidt
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf–Krehl–Strasse 7–11, 68167, Mannheim, Germany
| | - Joachim E. Fischer
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf–Krehl–Strasse 7–11, 68167, Mannheim, Germany
| | - Julian F. Thayer
- The Ohio State University, Department of Psychology, 1835 Neil Avenue, 43210, Columbus, Ohio, United States of America
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226
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Burger AM, Verkuil B, Van Diest I, Van der Does W, Thayer JF, Brosschot JF. The effects of transcutaneous vagus nerve stimulation on conditioned fear extinction in humans. Neurobiol Learn Mem 2016; 132:49-56. [DOI: 10.1016/j.nlm.2016.05.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/13/2016] [Accepted: 05/20/2016] [Indexed: 12/30/2022]
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227
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Guiraud D, Andreu D, Bonnet S, Carrault G, Couderc P, Hagège A, Henry C, Hernandez A, Karam N, Le Rolle V, Mabo P, Maciejasz P, Malbert CH, Marijon E, Maubert S, Picq C, Rossel O, Bonnet JL. Vagus nerve stimulation: state of the art of stimulation and recording strategies to address autonomic function neuromodulation. J Neural Eng 2016; 13:041002. [PMID: 27351347 DOI: 10.1088/1741-2560/13/4/041002] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Neural signals along the vagus nerve (VN) drive many somatic and autonomic functions. The clinical interest of VN stimulation (VNS) is thus potentially huge and has already been demonstrated in epilepsy. However, side effects are often elicited, in addition to the targeted neuromodulation. APPROACH This review examines the state of the art of VNS applied to two emerging modulations of autonomic function: heart failure and obesity, especially morbid obesity. MAIN RESULTS We report that VNS may benefit from improved stimulation delivery using very advanced technologies. However, most of the results from fundamental animal studies still need to be demonstrated in humans.
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Affiliation(s)
- David Guiraud
- Inria, DEMAR, Montpellier, France. University of Montpellier, DEMAR, Montpellier, France
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Murray AR, Atkinson L, Mahadi MK, Deuchars SA, Deuchars J. The strange case of the ear and the heart: The auricular vagus nerve and its influence on cardiac control. Auton Neurosci 2016; 199:48-53. [PMID: 27388046 DOI: 10.1016/j.autneu.2016.06.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/20/2016] [Indexed: 02/07/2023]
Abstract
The human ear seems an unlikely candidate for therapies aimed at improving cardiac function, but the ear and the heart share a common connection: the vagus nerve. In recent years there has been increasing interest in the auricular branch of the vagus nerve (ABVN), a unique cutaneous subdivision of the vagus distributed to the external ear. Non-invasive electrical stimulation of this nerve through the skin may offer a simple, cost-effective alternative to the established method of vagus nerve stimulation (VNS), which requires a surgical procedure and has generated mixed results in a number of clinical trials for heart failure. This review discusses the available evidence in support of modulating cardiac activity using this strange auricular nerve.
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Affiliation(s)
- Aaron R Murray
- School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - Lucy Atkinson
- School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - Mohd K Mahadi
- School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT, United Kingdom; Faculty of Pharmacy, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Susan A Deuchars
- School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT, United Kingdom
| | - Jim Deuchars
- School of Biomedical Sciences, University of Leeds, Leeds, LS2 9JT, United Kingdom.
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229
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Depression and resting state heart rate variability in children and adolescents — A systematic review and meta-analysis. Clin Psychol Rev 2016; 46:136-50. [DOI: 10.1016/j.cpr.2016.04.013] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 04/18/2016] [Accepted: 04/23/2016] [Indexed: 12/13/2022]
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231
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Rejecting deep brain stimulation artefacts from MEG data using ICA and mutual information. J Neurosci Methods 2016; 268:131-41. [PMID: 27090949 DOI: 10.1016/j.jneumeth.2016.04.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recording brain activity during deep brain stimulation (DBS) using magnetoencephalography (MEG) can potentially help clarifying the neurophysiological mechanism of DBS. The DBS artefact, however, distorts MEG data significantly. We present an artefact rejection approach to remove the DBS artefact from MEG data. NEW METHODS We developed an approach consisting of four consecutive steps: (i) independent component analysis was used to decompose MEG data to independent components (ICs); (ii) mutual information (MI) between stimulation signal and all ICs was calculated; (iii) artefactual ICs were identified by means of an MI threshold; and (iv) the MEG signal was reconstructed using only non-artefactual ICs. This approach was applied to MEG data from five Parkinson's disease patients with implanted DBS stimulators. MEG was recorded with DBS ON (unilateral stimulation of the subthalamic nucleus) and DBS OFF during two experimental conditions: a visual attention task and alternating right and left median nerve stimulation. RESULTS With the presented approach most of the artefact could be removed. The signal of interest could be retrieved in both conditions. COMPARISON WITH EXISTING METHODS In contrast to existing artefact rejection methods for MEG-DBS data (tSSS and S(3)P), the proposed method uses the actual artefact source, i.e. the stimulation signal, as reference signal. CONCLUSIONS Using the presented method, the DBS artefact can be significantly rejected and the physiological data can be restored. This will facilitate research addressing the impact of DBS on brain activity during rest and various tasks.
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Rossi S, Santarnecchi E, Valenza G, Ulivelli M. The heart side of brain neuromodulation. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2016; 374:rsta.2015.0187. [PMID: 27044999 DOI: 10.1098/rsta.2015.0187] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 05/03/2023]
Abstract
Neuromodulation refers to invasive, minimally invasive or non-invasive techniques to stimulate discrete cortical or subcortical brain regions with therapeutic purposes in otherwise intractable patients: for example, thousands of advanced Parkinsonian patients, as well as patients with tremor or dystonia, benefited by deep brain stimulation (DBS) procedures (neural targets: basal ganglia nuclei). A new era for DBS is currently opening for patients with drug-resistant depression, obsessive-compulsive disorders, severe epilepsy, migraine and chronic pain (neural targets: basal ganglia and other subcortical nuclei or associative fibres). Vagal nerve stimulation (VNS) has shown clinical benefits in patients with pharmacoresistant epilepsy and depression. Non-invasive brain stimulation neuromodulatory techniques such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are also being increasingly investigated for their therapeutic potential in several neurological and psychiatric disorders. In this review, we first address the most common neural targets of each of the mentioned brain stimulation techniques, and the known mechanisms of their neuromodulatory action on stimulated brain networks. Then, we discuss how DBS, VNS, rTMS and tDCS could impact on the function of brainstem centres controlling vital functions, critically reviewing their acute and long-term effects on brain sympathetic outflow controlling heart function and blood pressure. Finally, as there is clear experimental evidence in animals that brain stimulation can affect autonomic and heart functions, we will try to give a critical perspective on how it may enhance our understanding of the cortical/subcortical mechanisms of autonomic cardiovascular regulation, and also if it might find a place among therapeutic opportunities in patients with otherwise intractable autonomic dysfunctions.
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Affiliation(s)
- Simone Rossi
- Gaetano Valenza, Monica Ulivelli Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Brain Investigation and Neuromodulation Lab. (Si-BIN Lab.), Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy
| | - Emiliano Santarnecchi
- Gaetano Valenza, Monica Ulivelli Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Brain Investigation and Neuromodulation Lab. (Si-BIN Lab.), Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Gaetano Valenza
- Department of Information Engineering, and Research Center E. Piaggio, University of Pisa, 56122 Pisa, Italy Neuroscience Statistics Research Lab, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02115, USA Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Monica Ulivelli
- Gaetano Valenza, Monica Ulivelli Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Brain Investigation and Neuromodulation Lab. (Si-BIN Lab.), Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy
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Continuous intraoperative monitoring of vagus and recurrent laryngeal nerve function in patients with advanced atrioventricular block. Langenbecks Arch Surg 2016; 401:551-6. [DOI: 10.1007/s00423-016-1433-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/07/2016] [Indexed: 10/21/2022]
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Johnson RL, Murray ST, Camacho DK, Wilson CG. Vagal nerve stimulation attenuates IL-6 and TNFα expression in respiratory regions of the developing rat brainstem. Respir Physiol Neurobiol 2016; 229:1-4. [PMID: 27049312 DOI: 10.1016/j.resp.2016.03.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/19/2016] [Accepted: 03/22/2016] [Indexed: 01/01/2023]
Abstract
Pre-term infants are at greater risk for systemic infection due to an underdeveloped immune system. Airway infection results in immune up-regulation of early pro-inflammatory cytokines interleukin-1β (IL-1β), interleukin-6 (IL-6) and tumor necrosis factor-α (TNFα) in the brainstem. Current treatment for neonatal infection involves antibiotic administration. We previously showed that LPS injected into the trachea of neonatal rats causes changes in breathing and in IL-1β expression in the nucleus tractus solitarii (NTS) and hypoglossal motor nucleus (XII). We hypothesize that lipopolysaccharide (LPS) instilled in the trachea also causes the up-regulation of IL-6 and TNFα in the brainstem autonomic control regions. To test this hypothesis we injected LPS into the trachea of rat pups (postnatal ages 10-12days) and then assessed changes in IL-6 and TNFα. Vagal nerve stimulation has been used in the treatment of many inflammatory disorders, including sepsis. Our experiments show that VNS attenuates the upregulation of IL-6 and TNFα caused by LPS and may be a viable alternative to antibiotics.
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Affiliation(s)
- Rhaya L Johnson
- Center for Perinatal Biology, Dept. of Basic Sciences, Loma Linda University, United States
| | - Samuel T Murray
- Center for Perinatal Biology, Dept. of Basic Sciences, Loma Linda University, United States
| | | | - Christopher G Wilson
- Center for Perinatal Biology, Dept. of Basic Sciences, Loma Linda University, United States; Department of Pediatrics, Loma Linda University, United States.
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Verlinden TJM, Rijkers K, Hoogland G, Herrler A. Morphology of the human cervical vagus nerve: implications for vagus nerve stimulation treatment. Acta Neurol Scand 2016; 133:173-82. [PMID: 26190515 DOI: 10.1111/ane.12462] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The vagus nerve has gained a role in the treatment of certain diseases by the use of vagus nerve stimulation (VNS). This study provides detailed morphological information regarding the human cervical vagus nerve at the level of electrode implant. RESULTS Eleven pairs of cervical vagus nerves and four pairs of intracranial vagus nerves were analysed by the use of computer software. It was found that the right cervical vagus nerve has an 1.5 times larger effective surface area on average than the left nerve [1,089,492 ± 98,337 vs 753,915 ± 102,490 μm(2), respectively, (P < 0.05)] and that there is broad spreading within the individual nerves. At the right side, the mean effective surface area at the cervical level (1,089,492 ± 98,337 μm(2)) is larger than at the level inside the skull base (630,921 ± 105,422) (P < 0.05). This could imply that the vagus nerve receives anastomosing and 'hitchhiking' branches from areas other than the brainstem. Furthermore, abundant tyrosine hydroxylase (TH)- and dopamine ß-hydroxylase (DBH)-positive staining nerve fibres could be identified, indicating catecholaminergic neurotransmission. In two of the 22 cervical nerves, ganglion cells were found that also stained positive for TH and DBH. Stimulating the vagus nerve may therefore induce the release of dopamine and noradrenaline. A sympathetic activation could therefore be part of mechanism of action of VNS. Furthermore, it was shown that the right cervical vagus nerve contains on average two times more TH-positive nerve fibres than the left nerve (P < 0.05), a fact that could be of interest upon choosing stimulation side. We also suggest that the amount of epineurial tissue could be an important variable for determining individual effectiveness of VNS, because the absolute amount of epineurial tissue is widely spread between the individual nerves (ranging from 2,090,000 to 11,683,000 μm(2)). CONCLUSIONS We conclude by stating that one has to look at the vagus nerve as a morphological entity of the peripheral autonomic nervous system, a composite of different fibres and (anastomosing and hitchhiking) branches of different origin with different neurotransmitters, which can act both parasympathetic and sympathetic. Electrically stimulating the vagus nerve therefore is not the same as elevating the 'physiological parasympathetic tone', but may also implement catecholaminergic (sympathetic) effects.
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Affiliation(s)
- T. J. M. Verlinden
- Department of Anatomy & Embryology; Faculty of Health, Medicine and Life Sciences; Maastricht University; Maastricht the Netherlands
| | - K. Rijkers
- Department of Neurosurgery; School for Mental Health and Neuroscience; Maastricht University Medical Center; Maastricht the Netherlands
- Department of Neurosurgery; Zuyderland Hospital; Heerlen the Netherlands
| | - G. Hoogland
- Department of Neurosurgery; School for Mental Health and Neuroscience; Maastricht University Medical Center; Maastricht the Netherlands
| | - A. Herrler
- Department of Anatomy & Embryology; Faculty of Health, Medicine and Life Sciences; Maastricht University; Maastricht the Netherlands
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Invasive vagal nerve stimulation causes delayed autonomic dysregulation: A case report. Int J Cardiol 2016; 206:19-20. [DOI: 10.1016/j.ijcard.2015.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 12/12/2015] [Indexed: 11/17/2022]
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Editors T. Muscle Decline in Aging and Neuromuscular Disorders - Mechanisms and Countermeasures: Terme Euganee, Padova (Italy), April 13-16, 2016. Eur J Transl Myol 2016; 26:5904. [PMID: 27054021 PMCID: PMC4821223 DOI: 10.4081/ejtm.2016.5904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Not available.
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Townsley R, Hilmi O. The use of nerve monitoring in the placement of vagal nerve stimulators. Clin Otolaryngol 2016; 42:959-961. [DOI: 10.1111/coa.12519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2015] [Indexed: 11/28/2022]
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Akhtar H, Bukhari F, Nazir M, Anwar MN, Shahzad A. Therapeutic Efficacy of Neurostimulation for Depression: Techniques, Current Modalities, and Future Challenges. Neurosci Bull 2016; 32:115-26. [PMID: 26781880 PMCID: PMC5563754 DOI: 10.1007/s12264-015-0009-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/20/2015] [Indexed: 01/30/2023] Open
Abstract
Depression is the most prevalent debilitating mental illness; it is characterized as a disorder of mood, cognitive function, and neurovegetative function. About one in ten individuals experience depression at some stage of their lives. Antidepressant drugs are used to reduce the symptoms but relapse occurs in ~20% of patients. However, alternate therapies like brain stimulation techniques have shown promising results in this regard. This review covers the brain stimulation techniques electroconvulsive therapy, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, vagus nerve stimulation, and deep brain stimulation, which are used as alternatives to antidepressant drugs, and elucidates their research and clinical outcomes.
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Affiliation(s)
- Hafsah Akhtar
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan
| | - Faiza Bukhari
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan
| | - Misbah Nazir
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan
| | - Muhammad Nabeel Anwar
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan.
| | - Adeeb Shahzad
- Human Systems Lab, Department of Biomedical Engineering and Sciences, School of Mechanical and Manufacturing Engineering, National University of Sciences and Technology (NUST), Sector H-12, Islamabad, 44000, Pakistan
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240
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Meyers EE, Kronemberger A, Lira V, Rahmouni K, Stauss HM. Contrasting effects of afferent and efferent vagal nerve stimulation on insulin secretion and blood glucose regulation. Physiol Rep 2016; 4:e12718. [PMID: 26884478 PMCID: PMC4759047 DOI: 10.14814/phy2.12718] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/27/2016] [Accepted: 01/28/2016] [Indexed: 11/24/2022] Open
Abstract
Parasympathetic activation reduces hepatic glucose release and increases pancreatic insulin secretion in hyperglycemic conditions. Thus, vagal nerve stimulation (VNS) may potentially be effective in treating type II diabetes. To investigate this possibility, we hypothesized that VNS reduces blood glucose concentration [Glu] via insulin secretion. [Glu] together with insulin and glucagon serum concentrations were determined in anesthetized rats during baseline conditions and 120 min of cervical VNS with the nerve left intact for combined afferent and efferent VNS (n = 9) or the nerve sectioned proximal or distal from the stimulation electrode for selective efferent (n = 8) or afferent (n = 7) VNS, respectively. Afferent VNS caused a strong and sustained increase in [Glu] (+108.9 ± 20.9% or +77.6 ± 15.4%, after 120 min of combined afferent and efferent VNS or selective afferent VNS) that was not accompanied by an increase in serum insulin concentration. However, serum insulin levels increased significantly with selective efferent VNS (+71.2 ± 27.0% after 120 min of VNS) that increased [Glu] only temporarily (+28.8 ± 11.7% at 30 min of VNS). Efferent VNS initially increased serum glucagon concentration which remained elevated for 120 min when efferent VNS was combined with afferent VNS, but returned to baseline with selective efferent VNS. These findings demonstrate that afferent VNS causes a marked and sustained increase in [Glu] that is partly mediated by suppression of pancreatic insulin secretion. In contrast, efferent VNS stimulates pancreatic glucagon secretion that appears to be antagonized by insulin secretion in the case of selective efferent VNS. Selective efferent VNS may potentially be effective in treating type II diabetes.
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Affiliation(s)
- Erin E Meyers
- Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa
| | - Ana Kronemberger
- Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa
| | - Vitor Lira
- Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa
| | - Kamal Rahmouni
- Department of Pharmacology, The University of Iowa, Iowa City, Iowa
| | - Harald M Stauss
- Department of Health and Human Physiology, The University of Iowa, Iowa City, Iowa
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Abstract
PURPOSE Cervical vagus nerve stimulation (VNS) prevents manipulation-induced intestinal inflammation and improves intestinal transit in a mouse model of postoperative ileus (POI). Cervical VNS, however, is accompanied by cardiovascular and respiratory side effects. In view of potential clinical application, we therefore evaluated the safety and feasibility of abdominal VNS via laparoscopic approach in a porcine model. METHODS Six pigs were used in a non-survival study for both cervical and abdominal VNS. Two cardiac pacing electrodes were positioned around the right cervical and posterior abdominal vagus nerve and connected to an external stimulator. VNS was performed using four different settings (5 and 20 Hz, 0.5 and 1 ms pulse width) during 2 min with ECG recording. Laparoscopic VNS was timed and videotaped, and technical difficulties were noted. A validated National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire was used to evaluate the task and workload. RESULTS The procedure was completed in all pigs with 4-port laparoscopic technique. Cervical and abdominal VNS were performed after correct identification and isolation of the nerve, and positioning of the electrodes around the nerve. Median laparoscopic operating time was 16 min (range 8-33 min), and median NASA-TLX was 31 (range 11-74). No major complications were encountered. Reduction of heart rate was between 5.5 and 14% for cervical VNS and undetectable for abdominal VNS. CONCLUSION In a porcine model, laparoscopic VNS is feasible and safe with cardiac pacing electrodes and may lead to a similar novel approach in humans in the near future.
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Wang Z, Yu L, Huang B, Wang S, Liao K, Saren G, Zhou X, Jiang H. Low-level transcutaneous electrical stimulation of the auricular branch of vagus nerve ameliorates left ventricular remodeling and dysfunction by downregulation of matrix metalloproteinase 9 and transforming growth factor β1. J Cardiovasc Pharmacol 2016; 65:342-8. [PMID: 25502306 DOI: 10.1097/fjc.0000000000000201] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Vagus nerve stimulation improves left ventricular (LV) remodeling by downregulation of matrix metalloproteinase 9 (MMP-9) and transforming growth factor β1 (TGF-β1). Our previous study found that low-level transcutaneous electrical stimulation of the auricular branch of the vagus nerve (LL-TS) could be substituted for vagus nerve stimulation to reverse cardiac remodeling. So, we hypothesize that LL-TS could ameliorate LV remodeling by regulation of MMP-9 and TGF-β1 after myocardial infarction (MI). Twenty-two beagle dogs were randomly divided into a control group (MI was induced by permanent ligation of the left coronary artery, n = 8), an LL-TS group (MI with long-term intermittent LL-TS, n = 8), and a normal group (sham ligation without stimulation, n = 6). At the end of 6 weeks follow-up, LL-TS significantly reduced LV end-systolic and end-diastolic dimensions, improved ejection fraction and ratio of early (E) to late (A) peak mitral inflow velocity. LL-TS attenuated interstitial fibrosis and collagen degradation in the noninfarcted myocardium compared with the control group. Elevated level of MMP-9 and TGF-β1 in LV tissue and peripheral plasma were diminished in the LL-TS treated dogs. LL-TS improves cardiac function and prevents cardiac remodeling in the late stages after MI by downregulation of MMP-9 and TGF-β1 expression.
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Affiliation(s)
- Zhuo Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
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Hulsey DR, Hays SA, Khodaparast N, Ruiz A, Das P, Rennaker RL, Kilgard MP. Reorganization of Motor Cortex by Vagus Nerve Stimulation Requires Cholinergic Innervation. Brain Stimul 2016; 9:174-81. [PMID: 26822960 DOI: 10.1016/j.brs.2015.12.007] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/23/2015] [Accepted: 12/28/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Vagus nerve stimulation (VNS) paired with forelimb training drives robust, specific reorganization of movement representations in the motor cortex. The mechanisms that underlie VNS-dependent enhancement of map plasticity are largely unknown. The cholinergic nucleus basalis (NB) is a critical substrate in cortical plasticity, and several studies suggest that VNS activates cholinergic circuitry. OBJECTIVE We examined whether the NB is required for VNS-dependent enhancement of map plasticity in the motor cortex. METHODS Rats were trained to perform a lever pressing task and then received injections of the immunotoxin 192-IgG-saporin to selectively lesion cholinergic neurons of the NB. After lesion, rats underwent five days of motor training during which VNS was paired with successful trials. At the conclusion of behavioral training, intracortical microstimulation was used to document movement representations in motor cortex. RESULTS VNS paired with forelimb training resulted in a substantial increase in the representation of proximal forelimb in rats with an intact NB compared to untrained controls. NB lesions prevent this VNS-dependent increase in proximal forelimb area and result in representations similar to untrained controls. Motor performance was similar between groups, suggesting that differences in forelimb function cannot account for the difference in proximal forelimb representation. CONCLUSIONS Together, these findings indicate that the NB is required for VNS-dependent enhancement of plasticity in the motor cortex and may provide insight into the mechanisms that underlie the benefits of VNS therapy.
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Affiliation(s)
- Daniel R Hulsey
- School of Behavioral Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, GR41, Richardson, TX 75080-3021, USA
| | - Seth A Hays
- School of Behavioral Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, GR41, Richardson, TX 75080-3021, USA; Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080-3021, USA; Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080-3021, USA.
| | - Navid Khodaparast
- School of Behavioral Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, GR41, Richardson, TX 75080-3021, USA; Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080-3021, USA
| | - Andrea Ruiz
- Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080-3021, USA
| | - Priyanka Das
- Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080-3021, USA
| | - Robert L Rennaker
- School of Behavioral Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, GR41, Richardson, TX 75080-3021, USA; Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080-3021, USA; Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080-3021, USA
| | - Michael P Kilgard
- School of Behavioral Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, GR41, Richardson, TX 75080-3021, USA; Texas Biomedical Device Center, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080-3021, USA
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Desbeaumes Jodoin V, Lespérance P, Nguyen DK, Fournier-Gosselin MP, Richer F. Effects of vagus nerve stimulation on pupillary function. Int J Psychophysiol 2015; 98:455-9. [DOI: 10.1016/j.ijpsycho.2015.10.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/28/2015] [Accepted: 10/01/2015] [Indexed: 01/28/2023]
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Abstract
PURPOSE OF REVIEW When an individual loses a limb, he/she loses touch with the world and with the people around him/her. Somatosensation is critical to the feeling of connection and control of one's own body. Decades of attempts to replace lost somatosensation by sensory substitutions have been ineffective outside of the laboratory. This review discusses important recent results demonstrating chronic somatosensory restoration through direct peripheral nerve stimulation. RECENT FINDINGS Stimulation of peripheral nerves results in somatosensory perception on the phantom limb. Sensations are localized to several independent and functionally relevant locations, such as the fingertips, thenar eminence, ulnar border and dorsal surface. Patterns in stimulation intensity change the perception experience by the user, opening new dimensions on neuromodulation. SUMMARY Neural interfaces with sophisticated stimulation paradigms create a user's perception of his/her hand to touch and manipulate objects. The pattern of intensity and frequency of stimulation is critical to the quality and intensity of perceived sensation. Restoring feeling has allowed the individuals to, 'feel [my] hand for the first time since the accident,' and 'feel [my] wife touch my hand'. Individuals using a prosthetic hand with sensation can pull cherries and grapes from the stem, open water bottles and move objects without destroying these objects - all while audio and visually deprived. After regaining sensation, phantom pain is eliminated in individuals that had frequent, sometimes debilitating, pain following limb loss. With over 5 subject-years of experience, this work is leading the evolution of a new era in prostheses. Somatosensory prosthetics as a standard procedure to augment and restore somatosensation are now within our reach.
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Affiliation(s)
- Dustin J Tyler
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
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Janik R, Thomason LAM, Stanisz AM, Forsythe P, Bienenstock J, Stanisz GJ. Magnetic resonance spectroscopy reveals oral Lactobacillus promotion of increases in brain GABA, N-acetyl aspartate and glutamate. Neuroimage 2015; 125:988-995. [PMID: 26577887 DOI: 10.1016/j.neuroimage.2015.11.018] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/25/2015] [Accepted: 11/08/2015] [Indexed: 01/09/2023] Open
Abstract
The gut microbiome has been shown to regulate the development and functions of the enteric and central nervous systems. Its involvement in the regulation of behavior has attracted particular attention because of its potential translational importance in clinical disorders, however little is known about the pathways involved. We previously have demonstrated that administration of Lactobacillus rhamnosus (JB-1) to healthy male BALB/c mice, promotes consistent changes in GABA-A and -B receptor sub-types in specific brain regions, accompanied by reductions in anxiety and depression-related behaviors. In the present study, using magnetic resonance spectroscopy (MRS), we quantitatively assessed two clinically validated biomarkers of brain activity and function, glutamate+glutamine (Glx) and total N-acetyl aspartate+N-acetyl aspartyl glutamic acid (tNAA), as well as GABA, the chief brain inhibitory neurotransmitter. Mice received 1×10(9) cfu of JB-1 per day for 4weeks and were subjected to MRS weekly and again 4weeks after cessation of treatment to ascertain temporal changes in these neurometabolites. Baseline concentrations for Glx, tNAA and GABA were equal to 10.4±0.3mM, 8.7±0.1mM, and 1.2±0.1mM, respectively. Delayed increases were first seen for Glx (~10%) and NAA (~37%) at 2weeks which persisted only to the end of treatment. However, Glx was still elevated 4weeks after treatment had ceased. Significantly elevated GABA (~25%) was only seen at 4weeks. These results suggest specific metabolic pathways in our pursuit of mechanisms of action of psychoactive bacteria. They also offer through application of standard clinical neurodiagnostic techniques, translational opportunities to assess biomarkers accompanying behavioral changes induced by alterations in the gut microbiome.
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Affiliation(s)
- Rafal Janik
- Department of Medical Biophysics, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
| | - Lynsie A M Thomason
- Physical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
| | - Andrew M Stanisz
- McMaster Brain-Body Institute at St. Joseph's Healthcare Hamilton, T3304, Juravinski Tower, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada
| | - Paul Forsythe
- Department of Medicine, McMaster University, St. Joseph's Healthcare Hamilton, T3302, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada; McMaster Brain-Body Institute at St. Joseph's Healthcare Hamilton, T3304, Juravinski Tower, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada
| | - John Bienenstock
- Department of Pathology, McMaster University, St. Joseph's Healthcare Hamilton,, Juravinski Tower, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada; McMaster Brain-Body Institute at St. Joseph's Healthcare Hamilton, T3304, Juravinski Tower, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada
| | - Greg J Stanisz
- Department of Medical Biophysics, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Physical Sciences, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Department of Neurosurgery and Pediatrics Neurosurgery, Medical University of Lublin, Aleje Raclawickie 1, 20-059 Lublin, Poland.
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Abstract
Advances in biophysics, biology, functional genomics, neuroscience, psychology, psychoneuroimmunology, and other fields suggest the existence of a subtle system of "biofield" interactions that organize biological processes from the subatomic, atomic, molecular, cellular, and organismic to the interpersonal and cosmic levels. Biofield interactions may bring about regulation of biochemical, cellular, and neurological processes through means related to electromagnetism, quantum fields, and perhaps other means of modulating biological activity and information flow. The biofield paradigm, in contrast to a reductionist, chemistry-centered viewpoint, emphasizes the informational content of biological processes; biofield interactions are thought to operate in part via low-energy or "subtle" processes such as weak, nonthermal electromagnetic fields (EMFs) or processes potentially related to consciousness and nonlocality. Biofield interactions may also operate through or be reflected in more well-understood informational processes found in electroencephalographic (EEG) and electrocardiographic (ECG) data. Recent advances have led to the development of a wide variety of therapeutic and diagnostic biofield devices, defined as physical instruments best understood from the viewpoint of a biofield paradigm. Here, we provide a broad overview of biofield devices, with emphasis on those devices for which solid, peer-reviewed evidence exists. A subset of these devices, such as those based upon EEG- and ECG-based heart rate variability, function via mechanisms that are well understood and are widely employed in clinical settings. Other device modalities, such a gas discharge visualization and biophoton emission, appear to operate through incompletely understood mechanisms and have unclear clinical significance. Device modes of operation include EMF-light, EMF-heat, EMF-nonthermal, electrical current, vibration and sound, physical and mechanical, intentionality and nonlocality, gas and plasma, and other (mode of operation not well-understood). Methodological issues in device development and interfaces for future interdisciplinary research are discussed. Devices play prominent cultural and scientific roles in our society, and it is likely that device technologies will be one of the most influential access points for the furthering of biofield research and the dissemination of biofield concepts. This developing field of study presents new areas of research that have many important implications for both basic science and clinical medicine.
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Affiliation(s)
- David Muehsam
- Visual Institute of Developmental Arts and Sciences, National Institute of Biostructures and Biosystems, Bologna, Italy; and Consciousness and Healing Initiative, San Diego, California (Dr Muehsam)
| | - Gaétan Chevalier
- Developmental and Cell Biology Department, University of California Irvine, Irvine (Dr Chevalier)
| | - Tiffany Barsotti
- California Institute for Human Science, Encinitas, California (Ms Barsotti)
| | - Blake T Gurfein
- Osher Center for Integrative Medicine, University of California, San Francisco, (Dr Gurfein)
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248
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Qing KY, Ward MP, Irazoqui PP. Burst-Modulated Waveforms Optimize Electrical Stimuli for Charge Efficiency and Fiber Selectivity. IEEE Trans Neural Syst Rehabil Eng 2015; 23:936-45. [DOI: 10.1109/tnsre.2015.2421732] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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249
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Kampusch S, Kaniusas E, Széles JC. Modulation of Muscle Tone and Sympathovagal Balance in Cervical Dystonia Using Percutaneous Stimulation of the Auricular Vagus Nerve. Artif Organs 2015; 39:E202-12. [PMID: 26450637 DOI: 10.1111/aor.12621] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Primary cervical dystonia is characterized by abnormal, involuntary, and sustained contractions of cervical muscles. Current ways of treatment focus on alleviating symptomatic muscle activity. Besides pharmacological treatment, in severe cases patients may receive neuromodulative intervention such as deep brain stimulation. However, these (highly invasive) methods have some major drawbacks. For the first time, percutaneous auricular vagus nerve stimulation (pVNS) was applied in a single case of primary cervical dystonia. Auricular vagus nerve stimulation was already shown to modulate the (autonomous) sympathovagal balance of the body and proved to be an effective treatment in acute and chronic pain, epilepsy, as well as major depression. pVNS effects on cervical dystonia may be hypothesized to rely upon: (i) the alteration of sensory input to the brain, which affects structures involved in the genesis of motoric and nonmotoric dystonic symptoms; and (ii) the alteration of the sympathovagal balance with a sustained impact on involuntary movement control, pain, quality of sleep, and general well-being. The presented data provide experimental evidence that pVNS may be a new alternative and minimally invasive treatment in primary cervical dystonia. One female patient (age 50 years) suffering from therapy refractory cervical dystonia was treated with pVNS over 20 months. Significant improvement in muscle pain, dystonic symptoms, and autonomic regulation as well as a subjective improvement in motility, sleep, and mood were achieved. A subjective improvement in pain recorded by visual analog scale ratings (0-10) was observed from 5.42 to 3.92 (medians). Muscle tone of the mainly affected left and right trapezius muscle in supine position was favorably reduced by about 96%. Significant reduction of muscle tone was also achieved in sitting and standing positions of the patient. Habituation to stimulation leading to reduced stimulation efficiency was observed and counteracted by varying stimulation patterns. Experimental evidence is provided for significantly varied sympathovagal modulation in response to pVNS during sleep, assessed via heart rate variability (HRV). Time domain measures like the root mean square of successive normal to normal heart beat intervals, representing parasympathetic (vagal) activity, increased from 37.8 to 67.6 ms (medians). Spectral domain measures of HRV also show a shift to a more pronounced parasympathetic activity.
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Affiliation(s)
- Stefan Kampusch
- Institute of Electrodynamics, Microwave and Circuit Engineering, Vienna University of Technology, Vienna, Austria
| | - Eugenijus Kaniusas
- Institute of Electrodynamics, Microwave and Circuit Engineering, Vienna University of Technology, Vienna, Austria
| | - Jozsef C Széles
- University Clinic for Surgery, Medical University of Vienna, Vienna, Austria
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250
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Mercante B, Pilurzi G, Ginatempo F, Manca A, Follesa P, Tolu E, Deriu F. Trigeminal nerve stimulation modulates brainstem more than cortical excitability in healthy humans. Exp Brain Res 2015; 233:3301-11. [DOI: 10.1007/s00221-015-4398-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 07/27/2015] [Indexed: 12/30/2022]
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